PHARMACOLOGY FOR

DENTAL HYGIENIST
M.DJAMALUDIN,DR.,SPFK.,M.KES
DEPARTMENT OF PHARMACOLOGY
UNJANI MEDICAL FACULTY

TERMINOLOGY ON ANTIINFECTIVE AGENTS

Antiinfetive agents

Antimicrobial agents
Antibacterial agents
Antibiotic agents

Bactericidal
Bacteriostatic

 Blood serum level

Infection
Minimal lnhibitory Concentation (MIC)
Spectrum

Superinfection
Suprainfection
Synergism

Antagonism

ANTIINFECTIVE AGENTS

Antiinfective agents play important role in dentistry

because infection, after pain management, is the

dental problem for which drugs are most often
prescribed.
Dental infection can be divided into several types as
follows:
Caries, Localized and systemic dental
infection

Caries
Cariers produced by Streptococcus mutans, is the
first imporant dental infection of the newly erupting
teeth of the young patient.
Periodontal disease
In adult patient, the dental health care teams
biggest dental problem is peri0dontal disease

Localized dental infections

Most localized dental infections are extensions that

arise from either periodontic or endodontic related
sources.
For more localized dental infections, if adequate
drainage can be obtain, antiinfective agents are not
indicated unless he patient is immunocompromised.

SYSTEMIC INFECTIONS
Systemic

infection can identified because they

produce systemic symptoms such as fever, malaise,
and tachycardia.

PERIODONTAL MICROBES
Aggregatebacter actinomycetes comitans

Porphyromonas ginggivalis
Prevotella intermedia
Elkenella corrodens

Fusobacterium spp.
Campylobacter rectus (Wolinella recta)

Diseases, Conditions and drugs that

decrease resistence to infection
Addisons disease

AIDS-related complex
HIV
Alcoholis

Blood discrasias
Cancer
Cirrhosis of the liver

CLASSIFICATION OF ANTIINFECTIVE
AGENTS BACTERICIDAL OR
BACTERIOSTATIC
BACTERICIDAL

Aminoglycosides
Bacitracin
Cephalosporins
Metronidazole
Macrolides
Penicillin
Polymyxin

BACTERIOSTATIC
Chloramphenicol
Clindamycin
Macrolides
Spectinomycin
Sulphonamide
Tetracyclines
Trimethoprim

INDICATIONS FOR ANTIBMICROBIAL

AGENTS
Therapeutic Indications

Several factor that must be decided:

- Patient
Defence mechanism, when this defence lacking the
need for antimicrobial agents is more pressing
-Infection
Invasiveness, acuteness, severity, spreading, tendency of
infection
Prophylactic Indications

ANTIMICROBIAL USE IN DENTISTRY

INFECTION
D.O.C
PERIODONTAL DISEASE
Acute Necrotizing
Ulcerative ginggivitist
Penicillin VK
Amoxillin
Abscess (perio)
Penicillin VK
IJP
Doxycycline
Adult periodontitist
RAP

Not need drug

Doxycycline

ALTERNATIVE

Metronidazole
Tetracycline
Tetracycline
Amoxicillin + Metroidazole
Augmentin + Clavulanate
Clindamycin
Amoxicillin+Metron

ORAL INFECTION

Soft tissue infection

Abscess (cellulitis, post surgical pericoronitis)
Osteomyelitis

MIXED INFECTION INTENSIVE TO

PENICILLIN
Aerobes
Anaerobes and chronic infection
PROPHYLAXIS FOR INFECTIVE
ENDOCARDITIS
Prosthetic heart valve
Patent with LJP

PROPHYLACTIC INDICATIONS
Before a dental procedure (recomended) by the

American Heart Association and American Dental

Association:
- History of infective endocarditis
- Presence of heart valve prosthesis
- Congenital heart disease

GENERAL ADVERSE REACTIONS AND

DISADVENTAGES
Superinfection/ Suprainfection

Allergic Reaction
Drug Interaction

- Oral contraceptive
- Oral anticoagulant
- Other antiinfective

SUPERINFECTION(SUPRAINFECTION)
All antiinfective agents can produce an overgrowth of an
organism that is different from the original infecting
organism and resistant to the agent beiing used. The wider
spectrum and the longer administrating the agent the
greater chance of superinfection occuring.

ALLERGIC REACTIONS
All antiinfective agents have the potential to produce a

variety of allergic reactions.

Penicillin and Cephalosporine are more allergenic than
other agents. Many antiinfective agents, such as
erythromycin and clindamycin have a low allergenic
potential.

DRUG INTERACTIONS
Oral contracepties
Antibiotics decrease oral contraceptive efficacy by
increasing their clearance from the body.
Oral anticoagulants
Oral anticoagulants are vitamin K inhibitor, so
interfering with vit K could increase the anticoagulant
effect. Antiinfective agents reduce the bacterial flora that
produce vit K.

Gastrointestinal Complaints
The most serious gastrointestinal complain of any of
the antibiotics i.e erythromycin which linked with
clindamycin.
Pregnancy
The antimicrobial agents that can give during pregnancy
to treat infections are limited.

ERYTROMYCIN
Erythromycin, have not associated with teratogenicity and
are often used. The use of clindamycin probably also
acceptable, but before any antibiotics are used in the
pregnant dental patient, the patients obstetrician should
be contacted.

Metronidazole and tetracyclines are contraindicated

during pregnancy because of their effect on developing
teeth and skeleton.
Dose Form
Adult dose form of antibiotics are commonly tablets and
capsules. Children dose form, including liquid and
chewable antiabiotic dose form, contain sugar as their
sweetening agent.

 After the use of these agent sensititation has erupted the

dental health care worker should encourage the parent or

child to brush the childs teeth after the use of these
agents. Chewable can stick to the teeth, especially in the
pits. Long term administration of antibiotics could
increase the childs caries rate.

Cost
Cost is an important factor in choosing an antibiotic for

a patient. If the perfect antibiotic is chosen and

prescibed but the patient does not purchase the
medication because it is too expensive, then poor result
are likely. The best inexpensive antibiotic that can be
taken will be more effective than an expensive one that
cannot be purchased.

PENICILLIN
Divided in four major group:
1. Penicilin G and V
2. Penicillinase-resistant penicillin (Ampicillin)
3. Third group (Amoxicillin)
4. Extended-spectrum penicillins(Carbenicillin)
In dentistry, the first and the third groups are
commonly used.

PHARMACOKINETICS
ROA : p.o. and p.e.

Disadvantages of using oral rather than parenteral route

are that the blood levels rise slower, the blod levels are
less predictable because of variable absorption or lack of
patient compliance (biggest problem), and some
penicillin are degraded by gastric acid.

 Penicillin taken 1 or 2 hours after meals, but penicillin V

and amoxillin can be taken without regard to meals.

Distribution : Penicillin is distributed throught out the

body, with the exception of CSF, bone, and abscess.

Penicillin cross the placenta and appears in breast milk.

PENICILLINS
Source and Chemistry

Pharmacokinetics
Mechanism of Action
Spectrum

Resistance
Adverse Reaction
Toxicity

Allergiy and Hypersensitivity

MACROLIDES
Erythromycin

Azithromycin
Clarithromycin

They are bacteriostatic

Spectrum : Against Bordetella, Legionella and
Actinomyces, Mycoplasma p, Entamoeba
histolytica Chlamydia sp and Diphteria.

ERYTHROMYCIN
ROA : Po and pe (i.v and i.m)
Adverertse Reaction:
Stomatitis, nausea, vomitus,diarrhea and abdominal
cramp then other i.e cholestatic jaundice.
Drug Interaction:
Theophyllin, digoxin, triazolam, warfarin,
carbamazepine and cephalosporine

USES
As alternative therapy for patient with Penicillin

allergy and it is not effective against anaerobic

Bacteiodes sp, implicated in many dental infections.

Azithromycin And Clarythromycin

They are bacteriostatic and indicated as alternative
antibiotics in the treatment of common orofacial
infections caused by azithromycin and clarythromycin as
compared to erythromycin.
Drug interaction with some drugs by reduction
metabolism : astemizole, loratadine, carbamazepine,
digoxin and triazolam but does not effect either warfarin
or theophyllin.

CLARYTHROMYCIN
Increases the level of drugs metabolized in liver such as

theophyllin, carbamazepine, digoxin omeprazole and

astemizole.

TETRACYCLINE
Bacteriostatic
Pharmacokinetic
Spectrum
Adverse Rection:

GIT, Nauesa, vomitus, diarrhea, glossitis, stomatitis,

xerostomia, moniliasis.
On, diarrheal patient could occurs entteritis, even
candidiasis.

 Pseudomembranous colitis (Cl difficile)

Effect on teeth and bones

Hepatotoxic
Nephrotoxic

Hematologic effect
Super infection
Photo sensitivity

Allergy
Drug interaction

Enhanced effect of other drugs:

- Sulfonylurea
- Digoxin, lithium and theophyllin
DOXYCYCLINE reduced its action by barbiturat and
phenytoin.

 USES :

Tentracycline as drug of choice or alternative drug

for dental infection and often used for periodontal
conditions.

CLINDAMYCIN
Bacteriostatic, Effective against Gram positive and

anaerobic Bacteriodes sp.

Pharmacokinetics : r.o.a
Distribution throughout body exc : CSF
Spectrum : Gram positive and some Gram negative.
Adverse Reaction : Git (PMC) possible, super
infection, Allergy.

METRONIDAZOLE
Antiparasit.
For anaerobic bacteria.
Pharmacokinetics: p.o.
Bactericidal.

Adverse Reaction : GIT (Gastro Intestinal Tract), CNS

(Central Nerve System), Renal toxic, Oral effect

Drugs interaction.
Uses.
Medical.

DENTAL
Because of its anaerobic efficacy,metronidazole is useful

in the treatment of many periodontal infection.

CEPHALOSPORINE
Structurally related to penicillin.

Active for Gram positive and Gram negative bacteria.

ROA : P.O, I.M., IV.
MOA : Inhibit cell wall synthesis of bacteria.

Adverse Effect :

GIT, Nephrotoxicity, Super infection, Local Reaction

and allergy.

USES
Their dental use includes prophylaxis for patients with

risk joints who are undergoing dental procedures

likely to produce bleeding.
Alternative drug when other agents cannot be used.

RATIONAL USE OF ANTIINFECTIVE AGENTS IN

DENTISTRY
There are 3 stage

Stage 1 : Primary Gram positive, the mixed stage

(Penicillin qdd for 5-7 days).

Stage 2 Mixed infection (aerobes and anaerobes).
(Clindamycin, metronnidazole and Penicillin).
Stage 3 Exclusively anaerobes.

Referensi
Elene Bablenis Heveles, BS Pharm, PharmD,.et al

THANK YOU